Adulthood2

E – 25 female, Reactive Attachment Disorder in Adulthood

In February of 1997, I received a call from the adoptive mother of a twenty-five year-old East European girl asking if I would consider treating her daughter. She gave me the following account.

Her daughter came to them after spending her first year in a poverty- stricken orphanage. She was born prematurely and weighed 31/2 pounds. The story goes that she was brought to the orphanage in a shoe box and fed through an eye dropper. No one expected her to survive. When her adoptive parents picked her up at the airport, she was wrapped in a forlorn sweater. She was rigid when she was held and it was over a year before she cried.

The adoptive family had serious problems before her arrival. The mother had taken herself to a psychiatrist after nearly strangling her birth daughter and she attempted to regulate herself with alcohol. The father’s stability resided in a kind of depressive detachment. Several months after E’s arrival both parents left for Europe on a pre-scheduled and prolonged business trip and the baby was cared for by the father’s mother for several months.

E was developmentally delayed in every area. She had multiple tantrums on a daily basis, outbursts so violent and so desperate that they could only be calmed by hours of her father holding her. She was diagnosed with ADHD and LD and put in special classes from the beginning of her schooling. She had no friends and spent hours alone playing with Barbie dolls. She tried, as is typical of kids like E, to buy friends or bully others into playing with her. Her math was good but she could not read. She was routinely teased by her parents, sister and peers for tripping over things, spilling drinks and knocking over furniture. She cringed at her mother’s voice, never knowing when she would fly into an uncontrollable rage. She still punctuates her interactions with apologies, a habit that began as attempts to mollify her mother’s fury. She held herself aloof from touch, particularly from her mother’s which she perceives to be highly sexually charged.

E was developmentally delayed in every area. She had multiple tantrums on a daily basis, outbursts so violent and so desperate that they could only be calmed by hours of her father holding her. She was diagnosed with ADHD and LD and put in special classes from the beginning of her schooling. She had no friends and spent hours alone playing with Barbie dolls. She tried, as is typical of kids like E, to buy friends or bully others into playing with her. Her math was good but she could not read. She was routinely teased by her parents, sister and peers for tripping over things, spilling drinks and knocking over furniture. She cringed at her mother’s voice, never knowing when she would fly into an uncontrollable rage. She still punctuates her interactions with apologies, a habit that began as attempts to mollify her mother’s fury. She held herself aloof from touch, particularly from her mother’s which she perceives to be highly sexually charged.

When E was 8 her mother had surgery for breast cancer and left for a year to recover from the ordeal. E only remembers being relieved that she was gone. When she was ten, her paternal grandmother died suddenly, as did her special Ed teacher whom she loved, and when she was 11, her parents were divorced, ending years of sometimes savage conflict and leaving E in her mother’s custody. Father’s woman friend made it clear that she did not want to share her life with this man’s troubled daughters so E lost the relationship with her father, the only relationship that had ever offered her even a moment of sanctuary.

E went to private schools near her home until she was in tenth grade when she was sent to a boarding school for kids with learning disabilities. She tried on many identities. For E this was more than an adolescent phenomenon. She had no identity within so attempted to establish one from without. She reports going to films and becoming the character in the movie, in the way she walked, in her mannerisms, in her “core”.

By the time she was in high school, E was drinking heavily on a regular basis. She was unable to remain in college and began the precipitous decline that ended in the hospital after going back to the orphanage in which she had spent her first year. It was a horrifying experience of deprivation and neglect. There were two staff for fifty-five children. When they were out of control the staff threw puffed rice on the floor and E described how the kids would fight for the cereal. She is only now beginning to grasp the effect not only of her time in this place but also of the visit.

When she returned, E was increasingly unable to attend classes or to keep a job. By the time she was hospitalized she was drinking to blackout three to four times a week. She was picking up men in bars and would regularly find herself in the bed of some man she hardly knew. She was at great risk for AIDS and she was preoccupied with suicide, although not making suicide gestures. She had been in several counseling and psychotherapy relationships and had also been prescribed lithium, antidepressants and anti-anxiety agents.

At the time of the referral, E had been in a private psychiatric institution for seven months. They learned that she was going AWOL to drink with her friends only after she cracked up the car she’d rented. It was after this incident that her mother called me, feeling that this placement was failing the needs of her daughter. E came with these diagnoses: Alcoholism, Bipolar Disorder, Borderline Personality Disorder, ADHD, and LD. When I asked her mother if this was true bipolar she said, “If you think that if you drive a car fast enough it will fly, does that qualify?”

I asked if she had ever been diagnosed with an attachment disorder. Her mother had never heard of it. Either had, apparently, any of this girl’s treaters. I agreed to take E into my practice with the provision that all agreed to my use of Neurofeedback as well as talk therapy and that she be provided with support services to transition out of residential care back to her apartment.

E’s first TOVA results were suggestive of ADD and ADHD. Her ADHD score was -3.34 and omission errors significantly worsen from quarter 1 to quarter 2. She could not sit still and described herself as “jumping out of my skin”. She had 90% of the symptoms on both right and left side in assessment. She had no known seizure disorder and no stroke, no autoimmune disorder. Everything else we screen for, she was either experiencing or had experienced to some significant degree. She was, in short, profoundly disregulated emotionally, psychologically, physiologically and neurologically. She was in so much psychic and physical pain that she was motivated to change but she had little hope that she could do so. E has had 107 neurofeedback sessions with talk therapy and approximately 50 sessions that were talking therapy alone. The neurofeedback has been primarily right side SMR at C4, T4, T4-FP1, C4-PZ, C4-P4. Left side training was required for cognitive and language problems but it always ran two major risks- she would begin to drop or bump into things but even more importantly, she would begin to feel cold, raging and anti-social. I conducted left side training at C3, T3, T3-FP1 and C3-FP1. Of these protocols she did the least well with T4-FP1 and T3-FP1 and most well at C4-P4 at 11-14 and C3-FP1 at 14.5-17.5. For ten months, we trained two to three times a week. We now train once a week on average, sometimes less.


 PRESENT STATUS
E stopped drinking entirely within 4 months of beginning treatment. She is disinterested in alcohol. Within six months she was taking no medications, and beginning to sleep naturally. Within that same period she was easily able to transition out of support services.

She is working regular hours in a parttime position with the elderly. She has returned to college. She has been in a relatively stable relationship for over a year. She is able to visualize what she reads for the first time in her life. She has redecorated her apartment, a place that had looked the home office for Rent-A-Wreck.

She is saving money. She is driving a car. Most of her speech difficulties have cleared up. What were originally endless hours of perseverative complaint about boys or her difficult family are now thoughtful hours of insight and serious intent.

When I referred recently to the way our sessions used to be, she said, “I know, it embarrasses me. I can hardly believe I was ever like that.”

E is profoundly changed and profoundly baffled by it. It is difficult for her to put these changes into words but she has said “I am living in a different world.” She has an intact sense of continuity of self but often asks, ‘Who am I?’, and ‘What am I supposed to do now?’ She feels in this, a sense of responsibility to her ‘new’ self. No one would now describe her as alcoholic, bipolar, borderline, ADHD or attachment disordered. She still struggles some with reading and might still qualify as LD but this too has improved markedly. They would describe her as bright, loving, warm, generous, attentive, attuned and capable of deep insight into herself and into others.

E has been in this treatment for 16 months. This kind of progress, no, this kind of, I think, discovery of self, is unheard of in any talk therapy in this short a span, if ever. There is no doubt that E has made a very strong therapeutic alliance but even there, neurofeedback made a significant contribution.

Clearly this is not a case of pure neurofeedback. As the therapist, and one who deeply believes in the efficacy of talk therapy, I know that neurofeedback was the single most important part of this young woman’s rescue from the imprisonment of her early life. She will need more neurofeedback, as I suspect will be true for all children and adults with severe early attachment dilemmas, but she has gained a most solid and enduring sense of herself. She will also need more talk therapy as she continues to sort out and resolve or dissolve the knots of her terrible history. And she needs a therapist with whom to practice attachment, a place where she is safe to experience the most frightening of all human emotions, love. I have no doubt that she will do it all.

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